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Aetna

The following is our writeup on available plans from Aetna.

We stay in the know so you don’t have to! If this information is complex and overwhelming, feel free to reach out for complimentary assistance.

Senior 65 and over in PA, NJ, DE, or FL can call (855) 494-0097 to request a free consultation or click below to fill out an appointment request form.


Background

Aetna was founded in 1853 by Eliphalet Bulkeley.

Aetna Inc. is an American managed health care company, which sells Medigap (supplements) plans, Medicare Advantage plans, consumer and other traditional directed health care insurance plans and services, such as medical, pharmaceutical, behavioral health, dental, long-term care, and disability plans.

Aetna started out as a life insurance company and by 1853 added accident insurance. By 1899 Aetna entered into the health insurance field.

Aetna’s headquarters is located in Hartford CT and its subsidiaries include Coventry Health Care, Aetna International Inc. Aetna’s revenue in 2017 exceeded over 59 billion dollars and employs over 49,000 people. There were rumors that Aetna would move their operations to New York city in the next couple of years.

That plan was put on hold due to CVS reporting that they will purchase Aetna and keep them in Hartford CT.

A.M. Best recognizes that Aetna’s current level of liquidity is excellent and recent performance has been favorable with steady operating margins, low medical cost trends and improved operational efficiencies.

When enrolling in traditional Medicare, the Medicare recipient has one of two paths to choose from.

One, they could choose traditional Medicare as the primary insurance carrier which covers Parts A & B and covers about 80% of medical and hospital costs. Supplement Parts A & B with a medigap plan to pay the remaining 20% costs that traditional Medicare does not pay for. Then also add a stand-alone Part D drug plan to help pay for prescription costs.

Choice number two would be to purchase a Medicare Advantage plan which takes over for traditional Medicare. Like the Medigap plans you pay a monthly premium but you also share in the medical costs by paying copays and deductibles for your healthcare.

Medicare supplement insurance policies are identified by letters A through N. All supplement plans are standardized by Medicare. A standardized plan must offer the same basic benefits, no matter which insurance company sells it, so the difference comes down to customer service and cost.


Company Name Changes by State

Aetna sells medigap plans in Pennsylvania, New Jersey, Delaware, North Carolina, South Carolina and Florida.

Standardized medigap plans that are listed by Medicare are Plans A, B, C, D, F, high deductible Plan F, G, K, L, M and Plan N.

Aetna supplements sold in Pennsylvania are Plans A, B, C, D, F, high deductible F, G, and Plan N and sold under the name of “Continental Life Insurance Company.”

Aetna supplements in New Jersey are sold under the name of “Aetna Health Insurance Company.”

Supplemental insurance in Delaware, Florida, North Carolina and South Carolina are sold under the name of “Aetna Health and Life.”


Aetna participates in the Medicare crossover billing claims process. Medicare ensures claims are paid correctly by identifying the health benefits available to the appropriate beneficiary, coordinating the payment process, and ensuring that the primary payer, whether Medicare or other insurance, pays first whether you have traditional Medicare or an Advantage plan.

Plans A and B are much older plans which cover very few benefits and are usually very expensive as compared with the newer medigap plans. Plan C is also an older plan and usually as expensive but also more comprehensive than A and B. Most people purchase either Plans F, G or N which are also comprehensive plans but more affordable.

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) passed by Congress and signed into law on April 16, 2015 changed the law on various aspects of health care, including some Medicare Supplement plans. The new law states that on or after January 1, 2020, a Medicare Supplement policy that provides coverage of the Part B deductible may not be sold or issued to a newly eligible Medicare beneficiary. What is means is that Plan F will be discontinued after the said date. If you purchase Plan F prior to January 2020 you will not lose your plan, you will be “grandfathered” in.

If you enroll into the Medicare program by selecting Parts A&B as your primary insurance carrier, your medical and hospitalization will be covered by about 80%. With Medicare as your primary you will have an “open network” throughout the United States and you will never need a referral to see a specialist physician.


Supplement Plan F

If you purchase Plan F as your gap plan you will cover:

Basic, including 100% Part B coinsurance.

Skilled nursing facility co-insurance. $167.50 per day. Meaning if you require skilled care Medicare will pay days 1 through 20 and Plan F will pay days 21 to 100 days.

Part A deductible, which is the hospital deducible $1340.00

61 to 90 days $335 co-insurance

91 to 150 days $670 co-insurance

Part B deductible, which is anything medically necessary, $183.00 every calendar year

Part B Excess charges 100%. In numerous states around the United states, doctors and surgeons are allowed to bill 15% above Medicare’s allowed amount for covered listed procedures. For example, there are about 30 states where this could happen, NJ, NY and FL are three examples allowed to bill for excess charges.

Foreign Travel Emergency. Plan F will pay for up to $50,000 of care if you are on foreign land. In short, it should be enough money to stabilize you and transport you back into the United States for your care.

If you purchase Plan F, you would pay the monthly premium the insurance carrier charges, and the other 20% gap that Medicare does not pay will be paid by your secondary carrier. No deductibles and co-pays.


Supplement Plan G

If you purchase Plan G as your gap plan you will cover:

Basic, including 100% Part B coinsurance.
Skilled nursing facility co-insurance. $167.50 per day. Meaning if you require skilled care Medicare will pay days 1 through 20 and Plan F will pay days 21 to 100 days.

Part A deductible, which is the hospital deducible $1340.00

61 to 90 days $335 co-insurance

91 to 150 days $670 co-insurance

Does not cover the Part B calendar year deductible of $183.00

Part B Excess charges 100%. In numerous states around the United states, doctors and surgeons are allowed to bill 15% above Medicare’s allowed amount for covered listed procedures. For example, there are about 30 states where this could happen, NJ, NY and FL are three examples allowed to bill for excess charges.

Foreign Travel Emergency. Plan F will pay for up to $50,000 of care if you are on foreign land. In short, it should be enough money to stabilize you and transport you back into the United States for your care.
If you purchase Plan G, you would pay the monthly premium the insurance carrier charges and the calendar year Part B deducible of $183.00. No co-pays.


Supplement Plan N

If you purchase a Plan N as your gap plan you will cover:

Basic, including 100% Part B coinsurance, except up to a $20 copayment for a doctor visit, and up to a $50 copayment for an Emergency Room visit.

Skilled nursing facility co-insurance. $167.50 per day. Meaning if you require skilled care Medicare will pay days 1 through 20 and Plan F will pay days 21 to 100 days.

Part A deductible, which is the hospital deducible $1340.00

61 to 90 days $335 co-insurance

91 to 150 days $670 co-insurance

Does not cover the Part B calendar year deductible of $183.00

Part B Excess charges 100%. In numerous states around the United states, doctors and surgeons are allowed to bill 15% above Medicare’s allowed amount for covered listed procedures. For example, there are about 30 states where this could happen, NJ, NY and FL are three examples allowed to bill for excess charges.

Foreign Travel Emergency. Plan F will pay for up to $50,000 of care if you are on foreign land. In short, it should be enough money to stabilize you and transport you back into the United States for your care.
If you purchase Plan N, you would pay the monthly premium the insurance carrier charges and the calendar year Part B deducible of $183.00. Once your calendar year deducible is met, you are charged up to a $20 co-pay for doctor visits and a $50 co-pay for emergency room visits.

Plan N does not cover you for Part B Excess Charges.


Recent News

CVS Health Looks to Buy Aetna – watch the video below:

Summary
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Aetna Medicare Supplements
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